Provider Demographics
NPI:1649561036
Name:WISNIEWSKI, WILLIAM JAMES (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JAMES
Last Name:WISNIEWSKI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:998 CROOKED HILL RD BLDG 56
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-1019
Mailing Address - Country:US
Mailing Address - Phone:631-761-2177
Mailing Address - Fax:631-761-2282
Practice Address - Street 1:998 CROOKED HILL RD BLDG 56
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-1019
Practice Address - Country:US
Practice Address - Phone:631-761-2177
Practice Address - Fax:631-761-2282
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0883381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical